Improving HIV pre-exposure prophylaxis (PrEP) uptake and initiation: Process evaluation and recommendation development from a national PrEP program

Claudia S. Estcourt; Jennifer Macdonald; John Saunders; Rak Nandwani; Ingrid Young; Jamie Frankis; Dan Clutterbuck; Nicola Steedman; Lisa McDaid; Jenny Dalrymple; Paul Flowers

doi:10.1071/SH22170

Improving HIV pre-exposure prophylaxis (PrEP) uptake and initiation: Process evaluation and recommendation development from a national PrEP program

Claudia S. Estcourt^*
, Jennifer Macdonald
, John Saunders
, Rak Nandwani
, Ingrid Young
, Jamie Frankis
, Dan Clutterbuck
, Nicola Steedman
, Lisa McDaid
, Jenny Dalrymple
, Paul Flowers

^*Corresponding author for this work

PDSI (Programme Delivery & Service Improvement)

Research output: Contribution to journal › Article › peer-review

11 Citations (Scopus)

Abstract

Background: HIV pre-exposure prophylaxis (PrEP) is key to HIV transmission elimination but implementation is challenging and under-researched. We undertook a process evaluation of the first 2 years of a national PrEP program to explore barriers and facilitators to implementation and to develop recommendations to improve implementation, focusing on PrEP uptake and initiation. Methods: Stage 1 involved semi-structured telephone interviews and focus groups (September 2018-July 2019) with geographically and demographically diverse patients seeking/using/declining/stopping PrEP (n = 39), sexual healthcare professionals (n = 54), community-based organisation service users (n = 9) and staff (n = 15) across Scotland. We used deductive thematic analysis, to derive and then map key barriers and facilitators to priority areas that experts agreed would enhance uptake and initiation. In Stage 2, we used analytic tools from implementation science to systematically generate evidence-based, theoretically-informed recommendations to enhance uptake and initiation of PrEP. Results: Barriers and facilitators were multi-levelled and interdependent. Barriers included the rapid pace of implementation without additional resource, and a lack of familiarity with PrEP prescribing. Facilitators included opportunities for acquisition of practice-based knowledge and normalisation of initiation activities. We refined our 68 'long-list' recommendations to 41 using expert input and the APEASE (Acceptability, Practicability, Effectiveness, Affordability, Side-effects, and Equity) criteria. Examples include: provision of PrEP in diverse settings to reach all in need; co-produced, culturally sensitive training resources for healthcare professionals, with focused content on non-daily dosing; meaningful collaborative working across all stakeholders. Conclusions: These evidence-based, theory informed recommendations provide a robust framework for optimising PrEP uptake and initiation in diverse settings to ensure PrEP reaches all who may benefit.

Original language	English
Pages (from-to)	282-295
Number of pages	14
Journal	Sexual Health
Volume	20
Issue number	4
DOIs	https://doi.org/10.1071/SH22170
Publication status	Published - 15 May 2023

Bibliographical note

Funding Information:
CSE reports research grants from National Institute of Health Research UK, Chief Scientist Office of Scotland, Engineering and Physical Sciences Research Council, UK Clinical Research Collaboration, Health Protection Scotland, and European Centres for Disease Control. CSE is an Editor of Sexual Health, but was blinded from the peer review process for this paper. JM reports no competing interests. JS reports no competing interests. RN reports research grants from National Institute of Health Research UK, Chief Scientist Office of Scotland and non-executive director membership of the Board of Public Health Scotland from April 2020. IY reports no competing interests. JF reports no competing interests. DC reports no competing interests. NS reports no competing interests. LM reports no competing interests. JD reports no competing interests. PF reports research grants from National Institute of Health Research UK, Australian Research Council and Chief Scientist Office of Scotland.

Funding Information:
The funders had no role in study design, collection, management, analysis and interpretation of data; writing of the report and the decision to submit the report for publication. This work presents independent research funded by the Scottish Government Chief Scientist Office (reference number HIPS/17/47). LM was funded by the UK Medical Research Council and Chief Scientist Office of the Scottish Government Health and Social Care Directorates at the MRC/CSO Social and Public Health Sciences Unit, University of Glasgow (MC_UU_12017/11, SPHSU11; MC_UU_00022/3, SPHSU18).

Publisher Copyright:
© 2023 CSIRO. All rights reserved.

Keywords

Behaviour Change Wheel
HIV prevention
HIV/AIDS
PrEP
implementation study
pre-exposure prophylaxis
process evaluation
recommendation-development

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1071/SH22170

Cite this

Estcourt, C. S., Macdonald, J., Saunders, J., Nandwani, R., Young, I., Frankis, J., Clutterbuck, D., Steedman, N., McDaid, L., Dalrymple, J., & Flowers, P. (2023). Improving HIV pre-exposure prophylaxis (PrEP) uptake and initiation: Process evaluation and recommendation development from a national PrEP program. Sexual Health, 20(4), 282-295. https://doi.org/10.1071/SH22170

@article{ad0d55886feb4e4f9a0181092dbd1fcb,

title = "Improving HIV pre-exposure prophylaxis (PrEP) uptake and initiation: Process evaluation and recommendation development from a national PrEP program",

abstract = "Background: HIV pre-exposure prophylaxis (PrEP) is key to HIV transmission elimination but implementation is challenging and under-researched. We undertook a process evaluation of the first 2 years of a national PrEP program to explore barriers and facilitators to implementation and to develop recommendations to improve implementation, focusing on PrEP uptake and initiation. Methods: Stage 1 involved semi-structured telephone interviews and focus groups (September 2018-July 2019) with geographically and demographically diverse patients seeking/using/declining/stopping PrEP (n = 39), sexual healthcare professionals (n = 54), community-based organisation service users (n = 9) and staff (n = 15) across Scotland. We used deductive thematic analysis, to derive and then map key barriers and facilitators to priority areas that experts agreed would enhance uptake and initiation. In Stage 2, we used analytic tools from implementation science to systematically generate evidence-based, theoretically-informed recommendations to enhance uptake and initiation of PrEP. Results: Barriers and facilitators were multi-levelled and interdependent. Barriers included the rapid pace of implementation without additional resource, and a lack of familiarity with PrEP prescribing. Facilitators included opportunities for acquisition of practice-based knowledge and normalisation of initiation activities. We refined our 68 'long-list' recommendations to 41 using expert input and the APEASE (Acceptability, Practicability, Effectiveness, Affordability, Side-effects, and Equity) criteria. Examples include: provision of PrEP in diverse settings to reach all in need; co-produced, culturally sensitive training resources for healthcare professionals, with focused content on non-daily dosing; meaningful collaborative working across all stakeholders. Conclusions: These evidence-based, theory informed recommendations provide a robust framework for optimising PrEP uptake and initiation in diverse settings to ensure PrEP reaches all who may benefit.",

keywords = "Behaviour Change Wheel, HIV prevention, HIV/AIDS, PrEP, implementation study, pre-exposure prophylaxis, process evaluation, recommendation-development",

author = "Estcourt, \{Claudia S.\} and Jennifer Macdonald and John Saunders and Rak Nandwani and Ingrid Young and Jamie Frankis and Dan Clutterbuck and Nicola Steedman and Lisa McDaid and Jenny Dalrymple and Paul Flowers",

note = "Funding Information: CSE reports research grants from National Institute of Health Research UK, Chief Scientist Office of Scotland, Engineering and Physical Sciences Research Council, UK Clinical Research Collaboration, Health Protection Scotland, and European Centres for Disease Control. CSE is an Editor of Sexual Health, but was blinded from the peer review process for this paper. JM reports no competing interests. JS reports no competing interests. RN reports research grants from National Institute of Health Research UK, Chief Scientist Office of Scotland and non-executive director membership of the Board of Public Health Scotland from April 2020. IY reports no competing interests. JF reports no competing interests. DC reports no competing interests. NS reports no competing interests. LM reports no competing interests. JD reports no competing interests. PF reports research grants from National Institute of Health Research UK, Australian Research Council and Chief Scientist Office of Scotland. Funding Information: The funders had no role in study design, collection, management, analysis and interpretation of data; writing of the report and the decision to submit the report for publication. This work presents independent research funded by the Scottish Government Chief Scientist Office (reference number HIPS/17/47). LM was funded by the UK Medical Research Council and Chief Scientist Office of the Scottish Government Health and Social Care Directorates at the MRC/CSO Social and Public Health Sciences Unit, University of Glasgow (MC\_UU\_12017/11, SPHSU11; MC\_UU\_00022/3, SPHSU18). Publisher Copyright: {\textcopyright} 2023 CSIRO. All rights reserved.",

year = "2023",

month = may,

day = "15",

doi = "10.1071/SH22170",

language = "English",

volume = "20",

pages = "282--295",

journal = "Sexual Health",

issn = "1448-5028",

publisher = "CSIRO Publishing ",

number = "4",

}

Estcourt, CS, Macdonald, J, Saunders, J, Nandwani, R, Young, I, Frankis, J, Clutterbuck, D, Steedman, N, McDaid, L, Dalrymple, J & Flowers, P 2023, 'Improving HIV pre-exposure prophylaxis (PrEP) uptake and initiation: Process evaluation and recommendation development from a national PrEP program', Sexual Health, vol. 20, no. 4, pp. 282-295. https://doi.org/10.1071/SH22170

TY - JOUR

T1 - Improving HIV pre-exposure prophylaxis (PrEP) uptake and initiation

T2 - Process evaluation and recommendation development from a national PrEP program

AU - Estcourt, Claudia S.

AU - Macdonald, Jennifer

AU - Saunders, John

AU - Nandwani, Rak

AU - Young, Ingrid

AU - Frankis, Jamie

AU - Clutterbuck, Dan

AU - Steedman, Nicola

AU - McDaid, Lisa

AU - Dalrymple, Jenny

AU - Flowers, Paul

N1 - Funding Information: CSE reports research grants from National Institute of Health Research UK, Chief Scientist Office of Scotland, Engineering and Physical Sciences Research Council, UK Clinical Research Collaboration, Health Protection Scotland, and European Centres for Disease Control. CSE is an Editor of Sexual Health, but was blinded from the peer review process for this paper. JM reports no competing interests. JS reports no competing interests. RN reports research grants from National Institute of Health Research UK, Chief Scientist Office of Scotland and non-executive director membership of the Board of Public Health Scotland from April 2020. IY reports no competing interests. JF reports no competing interests. DC reports no competing interests. NS reports no competing interests. LM reports no competing interests. JD reports no competing interests. PF reports research grants from National Institute of Health Research UK, Australian Research Council and Chief Scientist Office of Scotland. Funding Information: The funders had no role in study design, collection, management, analysis and interpretation of data; writing of the report and the decision to submit the report for publication. This work presents independent research funded by the Scottish Government Chief Scientist Office (reference number HIPS/17/47). LM was funded by the UK Medical Research Council and Chief Scientist Office of the Scottish Government Health and Social Care Directorates at the MRC/CSO Social and Public Health Sciences Unit, University of Glasgow (MC_UU_12017/11, SPHSU11; MC_UU_00022/3, SPHSU18). Publisher Copyright: © 2023 CSIRO. All rights reserved.

PY - 2023/5/15

Y1 - 2023/5/15

N2 - Background: HIV pre-exposure prophylaxis (PrEP) is key to HIV transmission elimination but implementation is challenging and under-researched. We undertook a process evaluation of the first 2 years of a national PrEP program to explore barriers and facilitators to implementation and to develop recommendations to improve implementation, focusing on PrEP uptake and initiation. Methods: Stage 1 involved semi-structured telephone interviews and focus groups (September 2018-July 2019) with geographically and demographically diverse patients seeking/using/declining/stopping PrEP (n = 39), sexual healthcare professionals (n = 54), community-based organisation service users (n = 9) and staff (n = 15) across Scotland. We used deductive thematic analysis, to derive and then map key barriers and facilitators to priority areas that experts agreed would enhance uptake and initiation. In Stage 2, we used analytic tools from implementation science to systematically generate evidence-based, theoretically-informed recommendations to enhance uptake and initiation of PrEP. Results: Barriers and facilitators were multi-levelled and interdependent. Barriers included the rapid pace of implementation without additional resource, and a lack of familiarity with PrEP prescribing. Facilitators included opportunities for acquisition of practice-based knowledge and normalisation of initiation activities. We refined our 68 'long-list' recommendations to 41 using expert input and the APEASE (Acceptability, Practicability, Effectiveness, Affordability, Side-effects, and Equity) criteria. Examples include: provision of PrEP in diverse settings to reach all in need; co-produced, culturally sensitive training resources for healthcare professionals, with focused content on non-daily dosing; meaningful collaborative working across all stakeholders. Conclusions: These evidence-based, theory informed recommendations provide a robust framework for optimising PrEP uptake and initiation in diverse settings to ensure PrEP reaches all who may benefit.

AB - Background: HIV pre-exposure prophylaxis (PrEP) is key to HIV transmission elimination but implementation is challenging and under-researched. We undertook a process evaluation of the first 2 years of a national PrEP program to explore barriers and facilitators to implementation and to develop recommendations to improve implementation, focusing on PrEP uptake and initiation. Methods: Stage 1 involved semi-structured telephone interviews and focus groups (September 2018-July 2019) with geographically and demographically diverse patients seeking/using/declining/stopping PrEP (n = 39), sexual healthcare professionals (n = 54), community-based organisation service users (n = 9) and staff (n = 15) across Scotland. We used deductive thematic analysis, to derive and then map key barriers and facilitators to priority areas that experts agreed would enhance uptake and initiation. In Stage 2, we used analytic tools from implementation science to systematically generate evidence-based, theoretically-informed recommendations to enhance uptake and initiation of PrEP. Results: Barriers and facilitators were multi-levelled and interdependent. Barriers included the rapid pace of implementation without additional resource, and a lack of familiarity with PrEP prescribing. Facilitators included opportunities for acquisition of practice-based knowledge and normalisation of initiation activities. We refined our 68 'long-list' recommendations to 41 using expert input and the APEASE (Acceptability, Practicability, Effectiveness, Affordability, Side-effects, and Equity) criteria. Examples include: provision of PrEP in diverse settings to reach all in need; co-produced, culturally sensitive training resources for healthcare professionals, with focused content on non-daily dosing; meaningful collaborative working across all stakeholders. Conclusions: These evidence-based, theory informed recommendations provide a robust framework for optimising PrEP uptake and initiation in diverse settings to ensure PrEP reaches all who may benefit.

KW - Behaviour Change Wheel

KW - HIV prevention

KW - HIV/AIDS

KW - PrEP

KW - implementation study

KW - pre-exposure prophylaxis

KW - process evaluation

KW - recommendation-development

UR - https://www.scopus.com/pages/publications/85168431814

U2 - 10.1071/SH22170

DO - 10.1071/SH22170

M3 - Article

C2 - 37603534

AN - SCOPUS:85168431814

SN - 1448-5028

VL - 20

SP - 282

EP - 295

JO - Sexual Health

JF - Sexual Health

IS - 4

ER -

Improving HIV pre-exposure prophylaxis (PrEP) uptake and initiation: Process evaluation and recommendation development from a national PrEP program

Abstract

Bibliographical note

Keywords

UN SDGs

Access to Document

Other files and links

Fingerprint

Cite this